Giving medication down ET tube

[JPINFV]

Remember back to paramedic training...aspiration is a bad thing...why would we want to aspirate someone on purpose??

Yea.. and last time I checked there's a difference between injecting a load of stomach acid and partially digested food into a vein and injecting narcan or epi, or the other ET tube drugs (except oxygen).

 

[zzyzx]

Paramedic007 wrote, "I work as an educator with UCLA School of Medicine..."

I think you should clarify that you don't work for the school of medicine. You're an ACLS instructor. Sorry to be be anal, but you can't just say that.

 

[Shishkabob]

I lied, there's another drug that can go down the tube--- Albuterol.

 

[VentMedic]

I lied, there's another drug that can go down the tube--- Albuterol.

Albuterol is most effective if it is in the appropriate particle size and not poured.

However, there are other meds which have specific purposes that can be poured but unless you do Specialty transport such as neo/pedi or Flight, you may not have a need for them as a Paramedic.

 

[daedalus]

Yea.. and last time I checked there's a difference between injecting a load of stomach acid and partially digested food into a vein and injecting narcan or epi, or the other ET tube drugs (except oxygen).

The fluids can still create a diffusion problem. Where I go to school, it is considered bad form to pour fluid down into the lungs. We can actually inject ACLS meds sublingually before resorting to that. The protocol for SL injection is posted on Ventura EMSA's website.

I hate the idea of anything but gas down the tube. We hear stories of LA county paramedics literally pouring meds down until every time compressions are started on the chest, fluids shoot up through the tube. Why drown your patient in addition to their other problems?

 

[JPINFV]

The question then is, how much (especially if we're ignoring the efficacy question) does it take to cause a diffusion problem worth worrying about and are we talking one dose, or the stupidity of blindly popping caps and pouring down vials until you top off the ET tube like the gas tank of a car driving cross country?

Now, of course, if there are other options like sublingal, then that's awesome and I'm all for it. I just have trouble accecpting arguments like "ZOMG, asperating stomach contents is bad, therefore medications via ET tube is bad" or "X group is a bunch of idiots and manages to completely frack this up, therefore no one should do this."

 

[Shishkabob]

Albuterol is most effective if it is in the appropriate particle size and not poured.

There's a medical director here in DFW named Dr Yamato who oversees most of the mid cities. He's really aggressive in his protocols and gives his medics a lot of leeway.

In status asthmaticus refractory to nebulized albuterol amd all other treatments, he has his medics do albuterol down the tube. Once poured in, the medics turn the pt side to side like a rotisserie (sp) chicken to get the albuterol onto places it was able to nebulized. He's apparently had great success doing it.

 

[VentMedic]

In status asthmaticus refractory to nebulized albuterol amd all other treatments, he has his medics do albuterol down the tube. Once poured in, the medics turn the pt side to side like a rotisserie (sp) chicken to get the albuterol onto places it was able to nebulized. He's apparently had great success doing it.

If that medical director was to consult with some Pulmonologists they might be able to explain to him why it is the turning and not the pouring of albuterol down the tube that has the effect. Believe me, this has been seriously researched even by my RT department through out the years. Unless that doctor is doing pulmonary function measurements, he has little data to back it up. The albuterol may also be little more than a lavage to clear some mucus which NS is cheaper and just as effective.

 

[emtjack02]

Thank you smash.

Vent I was under the impression that lavaging with saline was not effective that is why they say not to do it..you know other than causing pneumonia (which yeah as far as this current discussion the status trumps the pneumonia).

 

[VentMedic]

Thank you smash.

Vent I was under the impression that lavaging with saline was not effective that is why they say not to do it..you know other than causing pneumonia (which yeah as far as this current discussion the status trumps the pneumonia).

I mentioned that earlier. We rarely if ever lavage with saline in Neo or Pedi and it is becoming rare in Adults.

JPINFV

The question then is, how much (especially if we're ignoring the efficacy question) does it take to cause a diffusion problem worth worrying about and are we talking one dose, or the stupidity of blindly popping caps and pouring down vials until you top off the ET tube like the gas tank of a car driving cross country?

There are many factors that will affect the absorption rate as well as the pH and solution base of the liquid. If you've ever seen surfactant given down the tube of a neonate you would think we were literally drowning the baby. In fact, we probably would if it was saline given in that same amount. If you look back through the literature for surfantant, you will see the many issues we did have in the early days especially with the different types as well as the synthetic products.

If you also look at the early studies for ACLS, you will may find the data on why some meds were chosen and some weren't. Sodium Bicarb was also studied at one time but that was discovered to have few to no absorption properties within the lungs but could dissolve mucus temporarily if used in the right ratio as to not cause irritation. I keep a small syringe handy when flying with babies to unclog an ETT instead of reintubating a baby in an isolette in a helicopter.

 

[medic417]

Paramedic007 wrote, "I work as an educator with UCLA School of Medicine..."

I think you should clarify that you don't work for the school of medicine. You're an ACLS instructor. Sorry to be be anal, but you can't just say that.

Big difference there. Do you know for a fact that the above is a fact?

 

[Smash]

Thank you smash.

You're welcome. I hate to see gross misconceptions thrown around and treated as gospel.

Very informative posts VentMedic, thank you.